Provider Demographics
NPI:1033181631
Name:HADDAD, MARWAN LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARWAN
Middle Name:LOUIS
Last Name:HADDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48303-0243
Mailing Address - Country:US
Mailing Address - Phone:248-842-7799
Mailing Address - Fax:
Practice Address - Street 1:2700 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4547
Practice Address - Country:US
Practice Address - Phone:248-844-3800
Practice Address - Fax:248-853-7833
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055000207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG31991Medicare UPIN
MI0N91960Medicare ID - Type Unspecified